Cash Acceleration

HomeTown Health

February 2010

Self Pay Control Points

Scheduling Pre-registration At admission / registration Financial Counseling At Discharge Collection follow-up Medicaid Eligibility on self pay balances Ntelagent review

Unbilled Dollars

Work 100% of accounts pending information from the business office

Work with Medical Records to resolve any accounts greater than hold days. DRG and APC assignment CMI

Work with other clinical areas to resolve any accounts greater than hold days.

Have ongoing process to resolve issues timely.

Electronic Claims / Billing

What is your billing backlog Hard copy claims Billing edits in host system Billing edits in electronic billing system Standard errors are corrected in system Clinical departments have specific error reporting

Interface with on-line Medicare edit system Claims that can go electronic are sent electronically Medicare supplemental claims are processed within 2

days Staffing is sufficient to get claims out the door daily Quality performance standards are in place

Charge Entry

Late Charges holding Late charges as a percent of total charges Number of days holding

Lost Charges Annual Charge Master Review

Missing modifiers / CCI edits Missing HCPCS / CPT Codes Incorrect codes Charge for all services delivered

Charge Entry Lag Period – one day

Medicare & Medicare RTP Report

Inpatient claims pending on report Outpatient claims pending on report Part B only claims pending on report Accounts should ideally be zero at the end of

every day (if not by noon time). Resolving issues DRG Transfer review

Rejections / Delay Tactics

NEVER re-mail a rejected claim the first time from a commercial payer. CALL!! Sometimes the payer will resolve over the phone OR at least accept a fax.

Be specific and demand immediate payment of “delay in payment” rejected claims

Develop transaction codes to specifically identify rejections. Know your prompt pay laws & insist on immediate payment & a

post payment review if necessary Make sure staff is educated & has a response for each delay

tactic by insurance company. Insurance Commissioner’s office: $204 Million recovered since

1995 (1-800-656-2298) http://www.inscomm.state.ga.us/ConsumerService/NewRegionalAssistance.aspx

Denials

Contractuals increasing? Review for trends and correct problem at the

initial site. Track by payer, reason and financial

consequence Denial transaction codes entered in system Denials as a percent of net revenue – less

than 2%

Zero Payment Review

Post zero payments & develop a daily report to identify.

Pull all zero paid claims in last 6 months Contractual adjustments Administrative adjustments Denials

Develop a report that indicates that adjustment is equal to or greater than 100% of charge total

If you don’t have internal staff to review – hire a reputable outsource company to review zero payments.

Managed Care Payment Review

Retro Payment Review of paid claims Development a report that indicates when a

contractual adjustment is equal to or greater than 85% of charge total (amount may vary by hospital).

Outsource paid claims for past year to a specialized vendor to review detail payments.

Install a proven contract management system to monitor payments if the dollar amounts justifies.

Managed Care Contracts

Have an experienced company do a 12-month Managed Care payment review.

Review all contracts to ensure carve-outs (when needed) for expensive drugs and implants.

Use Contract Management tracking system

AR Analysis

Review aging reports Blue Cross and Medicare: only 5% AR > 60

days old Commercial and Managed Care: only 5% AR

> 90 days old Medicaid

Third Party Follow-up Firm and persistent Know your ERISA plans

Collections and Working with Outsource Vendors Contact agencies and push collections

How many people assigned to your accounts What times are they calling Are incentives in place

Contact agencies for discounts if your facility approves.

Medicaid Eligibility Program Bank Loan Program Electronic Payment Processing

Dollar Value to your Hospital

Unbilled accounts Charge Entry Electronic Claims Medicare RTP Rejections Denials Zero Payment Underpayment Review AR Clean-up Collection Agency

Streamlined Self Pay

$50 - $75K one time pickup $100K $100K $100K $50K $50K $100K $100 - $250K $100 - $250K $25K - $50K

Self pay – Irene Barron